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Insurance Reviewer-Clinical SR

Company: US Oncology, Inc.
Location: Denton
Posted on: June 7, 2021

Job Description:

Overview Texas Oncology is looking for an Insurance Reviewer - Clinical Senior to join our team! This position is a remote, work from home role supporting our Denton practice location. Texas Oncology is the largest community oncology provider in the country and has approximately 600+ providers in 220+ sites across Texas and southeastern Oklahoma. Our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today-at Texas Oncology, we use leading-edge technology and research to deliver high-quality, high-touch, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis. Why work for us? Come join our team that is responsible for helping lead Texas Oncology in treating more patient diagnosed with cancer than any other provider in Texas. We offer our employees a competitive benefits package that includes Medical, Dental, Vision, Life Insurance, Short-term and Long-term disability coverage, a generous PTO program, a 401k plan that comes with a company match, a Wellness program that rewards you practicing a healthy lifestyle, and lots of other great perks such as Tuition Reimbursement, an Employee Assistance program and discounts on some of your favorite retailers. What does the Insurance Reviewer -Clinical Senior do? The Insurance Reviewer- Clinical, under direct supervision, reviews radiation regimens in accordance to reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards. Responsibilities The essential duties and responsibilities: Reviews, processes and audits the medical necessity for each patient radiation treatment and documentation of regimen relative to pathway adherence Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered radiation drugs. Obtains insurance authorization and pre-certification specifically for radiation services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. Updates coding/payer guidelines for clinical staff; tracks pathways and performs various other business office functions on an as needed basis. Qualifications The ideal candidate for the Insurance Reviewer -Clinical Senior position will have the following background and experience: High School Diploma or equivalent required. Minimum 3 years of medical insurance verification and authorization experience, and 3 years of clinical review experience required. Knowledge of medical coding to include CPT & ICD-10 strongly preferred. Proficiency in basic skills of Microsoft Excel strongly preferred. Must have strong organization, prioritization and adaptability skills.The ideal candidate for the Insurance Reviewer -Clinical Senior position will have the following background and experience: High School Diploma or equivalent required. Minimum 3 years of medical insurance verification and authorization experience, and 3 years of clinical review experience required. Knowledge of medical coding to include CPT & ICD-10 strongly preferred. Proficiency in basic skills of Microsoft Excel strongly preferred. Must have strong organization, prioritization and adaptability skills.The essential duties and responsibilities: Reviews, processes and audits the medical necessity for each patient radiation treatment and documentation of regimen relative to pathway adherence Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered radiation drugs. Obtains insurance authorization and pre-certification specifically for radiation services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. Updates coding/payer guidelines for clinical staff; tracks pathways and performs various other business office functions on an as needed basis.

Keywords: US Oncology, Inc., Denton , Insurance Reviewer-Clinical SR, Other , Denton, Texas

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